Case Study: Adult Deformity
- The patient is a 76-year-old retired attorney who practices recreational tango dancing who presented with severe low back pain and stiffness, left leg numbness and weakness and difficulty walking.
- He had severe weakness of his legs and an obvious curved spine.
AP and lateral X-rays show degenerative spondylolisthesis and scoliosis with left lumbar curve and severe disc collapse from L1 to L5.
Sagittal and coronal MRI sections showing severe arthritis, stenosis, scoliosis and spondylolisthesis
Axial MRI and CT sections showing severe arthritis with hypertrophic facets and stenosis.
- Degenerative adult scoliosis with severe lumbar spondylolisthesis and lumbar spinal stenosis
- MIS (minimally invasive surgery) L1-L5 XLIF with posterior percutaneous pedicle screws placed from a lateral position between muscle planes.
- 2.5 hours of operative time
- 20 cc blood loss
AP and lateral X-rays showing multilevel interbody cages placed through a lateral portal and percutaneous screws placed between muscle planes. Note the correction of the scoliotic deformity and restoration of the disc heights.
- The patient went home two days after surgery with improved function, decreased weakness, much better posture and significant improvement in his curved spine.
- Five weeks after surgery, he celebrated by taking a trip to Argentina.
- In a patient of these characteristics (elderly with multilevel disease), MIS surgery avoided the large muscle stripping of open back surgery, allowing this patient to recover rapidly with less pain. After this four-level fusion, the patient’s flexibility improved and he was able to touch his toes from a standing position.
Saint Barnabas Medical Center
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Formerly Lenox Hill Hospital